Healthcare Provider Details

I. General information

NPI: 1972837250
Provider Name (Legal Business Name): GABRIELA VILLANEDA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2009
Last Update Date: 06/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 TIFFANY RD 1117 TIFFANY
CANUTILLO TX
79835
US

IV. Provider business mailing address

1101 E SCHUSTER AVE
EL PASO TX
79902-4659
US

V. Phone/Fax

Practice location:
  • Phone: 915-383-4552
  • Fax:
Mailing address:
  • Phone: 915-544-8484
  • Fax: 915-496-0751

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: